Offenders sentenced to forensic psychiatric care do not consider their mental illness to be the main reason for their crimes.
Instead, they point to abuse, poverty, or anger toward a particular person, according to a new doctoral thesis by Pontus Höglund, a Ph.D. student at Lund University in Sweden, and ethics coordinator in forensic psychiatry in Skåne.
For his research, Höglund conducted interviews with Swedish forensic psychiatry patients and staff about the relationship between mental illness and the ability to assess reality, make moral judgments, and control one’s actions.
Of the 46 patients interviewed, only four considered their mental illness as the sole cause for their actions, he reported.
Some found the disease to be a contributing factor, but the majority did not believe the disease to be the cause at all.
He recounts one patient, who murdered his wife when she wanted to leave him, who stated: “You don’t have to be ill to do it — it’s more than enough to be sad and angry.”
According to the patients, substance abuse and social destitution were important factors in their crimes.
This is consistent with epidemiological studies of the relationship between violence and mental illnesses, according to Höglund. The relationship initially seen in these studies disappears if you take into account factors such as alcohol and social circumstances, he noted.
“Extremely few of the people who are mentally ill commit crimes,” he said. “The connection between alcohol and violence is, on the other hand, clear, which means that anyone who wants to be safe should first and foremost beware of alcohol and not those who are mentally ill.”
Difficulty controlling one’s actions and finding alternative measures was present in many of the patients’ stories, regardless of their psychiatric diagnosis, he found.
Yet it is mainly the diagnoses that determine whether a person who committed a crime is considered to have done so because of a “severe mental disorder” and is to receive forensic psychiatric care rather than prison.
“In the worst case scenario, we focus on the wrong factors using the wrong methods — both within psychiatric diagnostics, liability assessment, and care and treatment,” he said.
He believes we should listen more to the individuals’ own assessments of their abilities (or inabilities) and actions.
“Many of the staff members believed that the patients would be both unwilling and unable to answer my questions,” he recounts. “But it turned out that they were happy to share their experiences, and were most capable of discussing these relatively complex matters.”
The thesis also includes an interview study with forensic psychiatric staff, who were initially asked to assess 12 psychiatric diagnosis with the potential to damage one’s accountability.
The result showed almost no significant differences: Schizophrenia, dementia, and mental retardation were regarded as most potential to damage one’s accountability, while bipolar disorder and autism spectrum disorders were seen as moderately potential. Personality disorders were attributed low damage potential.
When asked to describe their reasoning, two-thirds of the staff responded they had not thought about these issues before.
Höglund said he finds this to be a bit worrisome.
“A majority of the 150 professionals that I interviewed had never thought about the relationship between mental illness and responsible actions, a correlation which forms the cornerstone of forensic psychiatry,” he said. “Adding the almost identical rating of the diagnoses, you get what I call ‘unconscious consensus,’ a quite dangerous state, almost on the verge of madness.”
Source: Lund University